ILCAAAP News, April 2004, Volume 67, No. 1

Save a Life - End Underage Drinking

Before another unsuspecting college student dies of alcohol poisoning or another high-schooler is mangled in an alcohol-related traffic accident, the gravity of underage drinking needs to be brought once more into the spotlight of public awareness. Alcohol is the drug most frequently used by American teenagers. It is consumed more frequently than all other illicit drugs combined and is the drug most likely to be associated with injury or death.

Underage drinking is a critical public health issue in America and represents just the tip of the iceberg. Alcohol is a drug that can affect judgment, coordination and long-term health. In fact, research suggests that early use of alcohol by teenagers may contribute significantly to dependence on alcohol and other drugs later in life, with 40% of children who begin using alcohol before the age of 13 becoming alcoholics at some point in their lives.

Yet there are those who would dismiss underage drinking as a "youthful indiscretion" -a rite of passage from adolescence into adulthood. Many underage drinkers are often first presented with alcohol in their own dining rooms, living rooms and kitchens. Alcohol is strongly marketed to underage drinkers and associated with athletic and social events popular with high-school and college students. Establishments knowingly serve underage drinkers, often with a wink and a nod to fake identification.

"Sure, alcohol use by minors can be a rite of passage - passage for some young souls into a lifetime of broken promises, broken families, and broken lives," says Stacia Murphy, president of the National Council on Alcoholism.

"Alcohol is a drug - a powerful, mood-altering drug," says Dr. Robert Morse, chair of the NCADD Medical/Scientific Committee and recently retired from the world-famous Mayo Clinic where he was director of addictive disorders. "Over the past two decades, scientific research has revolutionized our understanding of how drugs affect the brain. We now know that prolonged, repeated drug and alcohol use can result in fundamental, long-lasting changes in brain structure and functioning."

Unfortunately, binge drinking, the most prevalent form of underage drinking, is as common as it was in the early 1990s, indicating that efforts to combat the phenomenon have so far failed. According to researchers at the Harvard School of Public Health, 44% of U.S. college students engaged in binge drinking and over half the binge drinkers, almost one in four students, were frequent binge drinkers, that is, they binged three or more times in a two week period.

"A well-publicized epidemic of binge drinking on the nation's college campuses has given an unwelcome twist to the phrase "institutions of higher learning," says Murphy. "You've seen the footage on television news programs and print publications: young men and women literally pouring beer and other alcoholic beverages down their throats without any regard for the tragic consequences that typically follow from this kind of behavior. These students think they're having a great time, being 'grown-up.' Unfortunately, as many as 360,000 of the nation's 12 million undergraduates will ultimately die from alcohol-related causes. This is more than the total number who will be awarded advanced degrees."

While the issue of underage drinking is a complex problem, one which can only be solved through a sustained and cooperative effort between parents, schools, community leaders, and the children themselves, there are three areas which have proven to be effective in prevention of underage drinking: curtailing the availability of alcohol, consistent enforcement of existing laws and regulations, and changing norms and behaviors through education. In addition, the alcohol beverage industry has a responsibility to discourage underage drinking and to curtail advertising and marketing that appeal to underage youth.

As a society, we've got to do a far better job persuading our citizens and our young people that alcohol use is a dead end, that they are playing Russian roulette, not only with their own lives, but with the lives of friends, neighbors, and loved ones.

National Council on Alcoholism and Drug Dependence, Inc., Sponsors of Alcohol Awareness Month

Doctors Use Casino as Lab to Test Secondhand Smoke

By Eric Nagourney

If you're looking for a nice smoky place, it is hard to do better than some casinos.

So when scientists from the University of Minnesota wanted to see how people were affected by secondhand tobacco smoke, they asked a group of volunteers to roam among the slot machines and gambling tables for a while to see what happened.

After just four hours or so, the volunteers had significant amounts of a biochemical marker in their urine traceable only to a known carcinogen in tobacco. Writing in Cancer Epidemiology Biomarkers & Prevention, a medical journal, they said the study was the first to look at carcinogen levels in people exposed to smoke in a commercial setting.

For the study, the researchers recruited 20 volunteers and asked them to spend time in a casino identified only by its location, the upper Midwest. Although their exposure to the smoke was limited, the researchers said they had to wrestle with a number of ethical issues in creating the study.

"We thought about this a lot," Dr. Anderson said. Apart from the ethics of exposing people to smoke - no matter how short the time - there was also the question of exposing them to gambling, which can also be addictive, and whether that was right.

"We didn't want to introduce anybody to a casino for the first time," Dr. Anderson said.

The researchers decided to recruit people who were occasional visitors to casinos and told them to do whatever they would normally do. A University of Minnesota institutional review board looked at the ethical issues and approved the research.

The volunteers were chosen if they were generally in good health. They could not take part if they had had "even a puff' of tobacco smoke in the two previous years or lived with a smoker or worked in a place that regularly had tobacco smoke. In the days before going to the casino, they were also asked to avoid tobacco smoke.

Before entering the casino, the volunteers provided urine samples for the researchers to establish base line levels of the carcinogen marker, NNK. Urine samples were taken again over the 24 hours after the volunteers left the casino. When the samples were analyzed, they showed significantly elevated levels of the marker, the study said. The findings, the researchers said, raise important public health questions.

"We looked at people who went in there for four hours," the senior author, Dr. Stephen S. Hecht, said. "But how about the people who work there? Their exposure is going to be higher."

Even scientists who believe that secondhand smoke is hazardous acknowledge that its risk pales compared with smoking cigarettes directly. But people with sustained exposure to smoke may face a real threat to their health the researchers said.

Many casinos, including the one in the study, use sophisticated ventilation systems. But the body still absorbs carcinogens, the study found.

"I don't think filtration systems are the answer," Dr. Hecht said. "I think that's going to be a huge waste of money. The answer is to get rid of smoking from public spaces."

College Freshmen Drinking Less

Binge drinking continues to be a problem on the college campus, but a wide-ranging survey of U.S. college freshmen indicates that changes may be coming.

According to Linda Sax of the University of California at Los Angeles, who directs The American Freshman annual survey, those entering college across America this year party less and volunteer more.

This year's incoming freshmen are also more interested in politics, according to the survey that tallied responses from 276,449 students at 413 colleges and universities in the U.S.

Some of the survey's most encouraging findings include surging interest in volunteerism and declining interest in smoking, drinking and drug use. Fewer than half of the students reported occasional or frequent beer drinking (44.8 percent, compared to 73.7 percent in 1982).

Reprinted with permission from Monday Morning Report, Vol. 28, no. 4, Feb. 23, 2004.

Underage Youth Have Easy Access to Alcohol Web Sites

By Dr. Andrea G. Barthwell, Deputy Director
Office of Demand Reduction, Office of National Drug Control Policy

Despite alcohol industry marketing codes promising to limit access to only legal-age adults, nearly 700,000 in-depth visits to alcohol company web sites in the last six months of 2003 alone were from young people under the drinking age, according to a report by the Center on Alcohol Marketing and Youth (CAMY) at Georgetown University.

The report also found the majority of parental control software programs are largely ineffective at preventing youth from visiting these sites. Alcohol web sites feature an array of video games such as car races, air hockey and pinball, as well as downloadable customized music, interactive accessories and other content considered attractive to youth.

While the vast majority of the alcohol web sites reviewed by the Center asked users to affirm they were 21 or older or state their birth date, data demonstrate that this does not prevent underage users from accessing the sites.

Press release from The Center on Alcohol Marketing and Youth camy.org, March 9, 2004

Moderate Alcohol Consumption Linked to Brain Shrinkage

A study by researchers at the Johns Hopkins Bloomberg School of Public Health and other institutions found a link between low to moderate alcohol consumption and a decrease in the brain size of middle-aged adults. Brain atrophy is associated with impaired cognition and motor functions. The researchers also found that low or moderate consumption did not reduce the risk of stroke, which contradicts the findings of some previous studies. The study is published in the rapid access edition of Stroke: The Journal of the American Heart Association.

"Previous studies conducted with older adults found an association between heavy drinking, brain atrophy and an increased risk for stroke. We studied a younger, middle-aged population and found that low amounts of alcohol consumption are also associated with decreases in brain size," said Jingzhong Ding, PhD, lead author of the study and a research associate in the Department of Epidemiology at the School of Public Health. "Our findings do not support the hypothesis that low or moderate alcohol intake offers any protection against cerebral abnormalities or the risk of stroke in middle-aged adults."

For the study, Dr. Ding and his colleagues used magnetic resonance imaging (MRI) to measure the brains of 1,909 men and women, age 55 and older. The researchers categorized the participant's drinking habits either as never drank, former drinker, occasional drinker (less than one drink per week), low drinker (one to six drinks per week) or moderate drinker (seven to 14 drinks per week).

The researchers found as alcohol consumption increased, the MRI detected increases in the ventricular and sulcal areas of the brain, which are spaces that do not contain brain tissue and an indication of brain atrophy. Former drinkers and moderate drinkers were more likely to have infarctions compared to those who never drank without adjusting for other factors. After adjusting for factors such as smoking habits, body mass and income, the researchers found no reduction or protection in infarction associated with former drinkers or moderate drinkers.

News Release From Johns Hopkins University Bloomberg School of Public Health, December 4, 2003.